I remember the first gunshot wound I treated in the emergency department at Jacobi Hospital in the South Bronx 35 years ago. Only one of two I saw that month in the second busiest trauma ER in the country. Gang fight. Troubled youths. In the middle of the night. Hand guns.
We couldn’t save him. I was devastated. My chief resident, an aspiring trauma surgeon, took me aside and matter-of-factly told me, “You didn’t shoot him. You weren’t bleeding. All bleeding stops.”
Not terribly reassured at the time, I have come to realize that while everything he said was true, at the same time, none of what he said is true.
Fast forward to last week’s shootings. A school. A mall. Mentally ill people. A semi-automatic rifle. In broad daylight. All the words have been used up to describe this sad, unbelievable, senseless killing.
Moving on the descriptive to the prescriptive, I ask, “Did I shoot them? Am I bleeding? And does all bleeding stop?”
The answers are not obvious. Ask yourselves:
Did I shoot them? Yes, in a way. By allowing a culture of violence to evolve into one where we have unrestricted violence creep into every facet of life, without relief, without context, without considering the consequences. Graphically in video games, gratuitously in movies and on TV, and glaringly in the discourse of how we express ourselves with whom we disagree (e.g. the last election as case in point).
By allowing our “freedom” to carry firearms outstrip the commonsense that framed our constitution. Hunting rifles and firearms for protection do not resemble the military grade weapons that are finding their way into the hands of the mentally ill.
By allowing ourselves to ignore the ravages of mental illness that are becoming more and more prevalent in our children and in our society. How many of our children have a behavior problem and are on medications from an early age? My office is full of them. Oppositional defiance disorder, ADHD, bi-polar and much more. Where were these kids 30 years ago? They didn’t exist. And too many parents are ill-equipped to deal with these children, as are the schools. We are failing in our inabilities to get them help unless they are deemed a clear and imminent danger to themselves or others in that moment. Otherwise they roam free as adolescents and young men (almost all are men where hormonal realities more readily imprint violence as a solution to problems.)
Am I bleeding? Yes, I am. I am bleeding the optimism that drives my abilities to carry on a normal life where I try to bring safety and security, health and happiness to my family and my patients. As an observer, I am bleeding out my resilience to adapt to circumstances I cannot control. I am bleeding the energy I need to change what I can so this cannot happen again.
And does all bleeding stop? No, it doesn’t. As a parent, I know that these families will feel this bleeding for the rest of their lives. Some will never be able to resume, others will find a way.
Guns have always existed. They aren’t going away. Greater control may or may not help this situation. This was a greatly disturbed family. A greatly disturbed parent who left 3 military grade weapons in her home where she had a greatly disturbed “child.” A “child” who has had a lifetime of violence thrown at him so that the consequences of that violence have inoculated him to become immune to what happens in real life.
And so last week we were confronted by what is becoming a more common event. We remember Columbine for how unique it was. How many more names will we remember? How many more faces will we forget?
My Website
Follow me on Twitter
11 Comments
I do believe you’re an active Republican. Get your constituency to get out of bed with the NRA and stand down on stopping sane and sensible gun legislation. Begin with getting Republican law makers to stop standing in the way of re-instating the assault weapons ban.
Just a thought.
I don’t know where you get your “belief” in my political affiliation. I am a registered democrat who sees value to both sides of the discussion depending on the issue. I support candidates and issues on both sides.
It is unfortunate that you would make this into a “side of the aisle” issue when it is so much more complex. These guns were available 30 years ago and we did not see these rampages. We have a lot more to consider than just guns. Freedom of expression that has resulted in a violent culture. The rights of the “mentally” ill who can refuse medication or help until they are imminent dangers to themselves or society, and then it is too late. An increase in the stress levels of children who come from all sorts of situations and deal with the endocrinologic ravages of chronic cortisol stimulation and have poor impulse control or myriad other problems.
I believe these semi-automatics should not be available to the public. And have signed petitions on the subject.
I suggest you stop blaming the Republicans for everything that you think is wrong in this world and start to look problems through a lens that makes sense based on principles of mutual respect and legitimate (though opposing) points of view.
Mea culpa! I thought you were actively Republican! Sincerest apologies for aligning you with the wrong party.
I do not “blame the Republicans” for everything….just for the few things their Congressional caucus proudly takes ownership for: like stopping any and all gun control legislation. And the Grover Nordquist pledges. Those things are pretty much Republican positions on which they take very public stands.
Gun control legislation is but one leg of a national safety stool, but without it, we remain hostage to the gun lobby. In the case of Adam Lanza, his guns were all legally obtained and registered to his mother. Why she kept them around the house and available to her son when he “issues” will remain a mystery. Surely this was not a bolt out of the blue; she was aware of his problems and by all reports was a deeply concerned and conscientious parent. What that does not address, however, is the lack of mental health service to most of the citizens of this country. People who can afford to pay for therapists et al are fewer than one might think, and insurance severely limits the availablity of such services….as I am certain you are most acutely aware.
When one party advocates draconian cuts to social welfare programs without any hint of what happens to those people, I think we get to question that particular party’s motive. When that same party runs on a platform that denounces any sort of gun control, we also get to question their motives. I come away with a strange feeling that these two things are inexorably linked.
Now, it seems some Republican lawmakers are radically changing their position on gun contol. Maybe this time there will be an honest effort to get assualt weapons off the store shelves, closet shelves, and gun racks of America. We have to start someplace, and in order for this stuff to become law, we really do have to start with the politicians.
Again, my apologies for believing your were a Republican. I stand corrected.
Why in Israel does everyone have a gun and there are not these types of shootings? It is not all about gun control, although military grade weapons should stay in the military.
Funding of social programs has not yet shown to be effective in really helping people. Societal/cultural norms that have shifted and allowed us to accept violence as a way of life, in my opinion, is much more devastating.
And as for the political party, I don’t care if you think I am a Republican or a Democrat–both parties have their warts and have their share of blame and their platforms which I buy into or not depending on the issue.
Politicizing this tragedy is just making it worse.
Israel has some of the toughest gun AND ammo laws in the world : http://www.thedailybeast.com/articles/2012/12/16/gun-law-in-israel.html
If we ignore the politics of getting things done in the country, we will not get done the job that needs to be done. Both sides need to come together not only to construct and enact a sane gun law, but to recognize that insurance and social safety net programs have an important role to play in the identification and treatment of mental illness, and that, as we seem not to learn over and over, is a pivotal part of public safety.
Politics must be a part of this process since politics will be necessary to enact additional safety nets for the disturbed. A friend of a friend committed suicide this past weekend after fighting depression for years. VA told him he was not eligible for the services he needed since he was Coast Guard and not in a combat front. He’d used all his employee benefits, was too young for Medicare, too rich for MedicAid, and despite begging for assistance, he was left without medication, treatment, or help. Rather than let the demons he saw in Connecticut run wild and hurt his loved ones, he took his own life.
Yes, politics is definitely a part of this process.
As for Israel’s gun laws, 1 gun and 50 rounds of ammo per year? That’s enough to a lot of damage. But they don’t.
The political process of course is necessary, but it is not clearly demarcated down political party lines. The history of “mental illness” is a long and sad one with plenty of blame to go around.
I am sorry about the friend of your friend. We are indeed in need of more accessible mental health services. We are also in need of prevention–and I still maintain that includes addressing our culture of violence, stress, and other factors which increase mental illnesses.
Not a political issue. Also not a gun control issue. It’s a societal issue.
We are all responsible for the shootings. We are all bleeding. I hope that now is finally the moment when we can speak respectfully, listen openly, and finally find a way to come together to staunch the bleeding. The problems of violence and profound disaffection that are plaguing our country are political and social and spiritual all intertwined. Looking for and expecting a simple, short term solution will only lead us in a circle to more frustration. We are facing an incredibly complex and deep seated problem that will take time, immense measures of cooperation, and societal creativity to solve.
Thank you Jane for a profoundly deep, yet concise articulation of what I believe to be the real crisis in America.
Guns need to be tightly regulated, but what needs to be regulated even more tightly is our mental health system.
Flashback to 40 years ago — mental asylums are everywhere, people are routinely warehoused for life for little more reason than “being odd.” They are forced to experimental treatments and kept in brutal conditions. Everyone with any semblance of being “unusual” gets warehoused there.
Flash forward to now — asylums are extinct, in fact mental health confinement is so rare that it is virtually impossible to have anyone confined. Even for violently mentally ill people, they get “stabilized” for a few weeks at most and then they are sent back to the streets with no supervision, no forced medication, nothing except a bus ticket and a “good luck” along with a kick in the ass on the way out.
There is a better way, and that better way is a medium road between the 2 extremes. We need asylums to come back. Not to warehouse all the “strange” people like we did 40 years ago, but to warehouse the KNOWN VIOLENT MENTALLY ILL who refuse to take their medications. This is a very SMALL slice of the entire mentally ill population. You’re talking about taking less than 1% of the total mentally ill population and putting them in mandatory confinement into asylums where they get MANDATORY depot injections, MANDATORY psychotherapy, MANDATORY counseling, and they get it for LIFE.
You see, this is not rocket science figuring out which of the paranoid schizophrenics are going to be violent. Most of them live uneventful lives as homeless folk under the bridge. But a small percentage of them, around 1%, are violent and they will ALWAYS BE VIOLENT and there’s no way you can release them into some kind of “group home” or “supervised release.” Those people need to be locked up 24/7, for life, with mandatory treatment.
Strongly stated with a lot of substance. Knowing who will become violent and when is not so easy.
Mental health “laws” and practices have definitely not kept up with the expanding needs of the population and society.
Thank you for your comment!